UnityPoint Health - Des Moines

BLS Forms

Course Paperwork





All Courses

  • Course Planning Form - submit 3 weeks prior to course if the CTC can share course information with any interested community members.
*If you modify the agenda set forth in the instructor manual, you must also submit this to the CTC for approval prior to the course.
  • Roster Form- submit within 2 weeks following the course 
  • Evaluation Form - tally and summarize and submit within 2 weeks following the course
    • Classroom Course evaluation
    • Online Course evaluation
  • Appropriate Skills Checklist(s)- submit within 2 weeks following the course (see below)
  • Card Order Form (pdf) or Card Order Form (Word) - use this form to order cards    
  • Equipment Reservation Form- use this form to reserve equipment
  • Instructor Credit Form - use this form when teaching for another Training Center

Heartsaver CPR AED, Heartsaver Pediatric First Aid CPR AED Courses, Bloodborne Pathogens

All Heartsaver courses use the same CPR AED & First Aid skills sheets for both Instructor-Led & Online course skills sessions. 

  • 2016 Heartsaver CPR AED Skills Testing Checklists (Adult, Child, Infant)
  • 2016 Heartsaver First Aid Skills Testing Checklist
  • Bloodborne Pathogens (optional test)

Healthcare Provider Instructor-Led Course or HeartCode BLS

  • Healthcare Provider Skills Testing: Adult and Infant BLS 
  • Written exam Answer sheet - providers must complete but not necessary to submit to Training Center  

HeartCode BLS Reference for students


Note: When utilizing online courses for participants, please submit the online course certificate as proof of completion of the written exam.